The Healthcare System in Malawi: What a French National Should Know

Malawi’s health system is under the authority of the Ministry of Health. The France Diplomatie and World Health Organization pages consulted for this guide do not detail the split between public, faith-based and private facilities: this information should be requested from the ministry and the insurer before departure. The WHO figures give the overall level: about 40 US dollars per capita and 6.5% of GDP, under-five mortality of about 38 per 1,000 live births and a healthy life expectancy of about 56 years.

The economic context weighs on the supply of care: GDP per capita is of the order of 500 US dollars according to France Diplomatie and 22% of the population is food insecure. For an expatriate, the practical conclusion is to rely on insurance that organises evacuation to a reference facility abroad for complex cases.

The guide healthcare systems of the world offers a method for comparing countries by their networks, rates and ease of access.

The pages read for this guide describe no compulsory national health insurance accessible to expatriates: cover rests on direct payment, employer arrangements and insurance contracts. The exact conditions (fees charged to foreigners, access to public facilities) are set by the Malawian authorities and should be confirmed with the ministry and the employer.

Malawi is not on the CLEISS list (the French liaison centre for international social security) of States bound to France by a social security agreement: the Carte Vitale opens no rights, and only the seconded employee keeps the French scheme, reimbursed on French rates according to Assurance Maladie (the French national health insurance).

France Diplomatie specifies that the French embassy cannot cover these costs, and that in any case there is neither a French embassy nor a consulate in Malawi. See healthcare reimbursement in Malawi.

France Diplomatie names no facility or first-contact doctor, and publishes no emergency number or list of hospitals for Malawi. It is therefore recommended, before departure, to ask the insurer or assistance provider for the list of approved providers, to save the assistance numbers and those of the Consulate General in Johannesburg, then to identify on the spot a care centre close to home.

Emergency roadside assistance is very limited according to France Diplomatie: the high road risk and the state of the roads weigh on emergency response times. Night-time travel outside built-up areas is discouraged, and minibuses, often poorly maintained and overloaded, are to be avoided.

Keep an up-to-date medical file (vaccinations, prescriptions, allergies, blood group). For hospitalisation, direct payment by the insurer avoids advancing the costs; see direct payment and medical evacuation.

France Diplomatie advises taking a personal medicine kit limited to the strict minimum, with the medicines in their original packaging and a prescription giving the international non-proprietary name, checking that they are authorised in Malawi and never buying medicines on the street.

For a chronic treatment, building up a stock before departure and asking a local doctor about equivalents reduce the risk of running out. The supply of medicines in the public sector should be confirmed with the ministry.

Dental and optical care fall under insurance contracts and the CFE (Caisse des Français de l’étranger, the French social security fund for expatriates); see expat health insurance.

The French vaccination schedule must be up to date. Depending on the length and conditions of the stay, France Diplomatie additionally cites yellow fever (mandatory for travellers arriving from endemic zones, to be done at least six days before entering the country), hepatitis A, typhoid fever, hepatitis B for frequent or prolonged stays, tuberculosis for children under 15, rabies and, depending on the epidemic context, chikungunya, dengue and mpox.

The diseases flagged are chikungunya, dengue, malaria (mild or severe forms, potentially fatal), Zika (consultation before travel for pregnant women), cholera, typhoid fever, hepatitis A, mpox, poliomyelitis, rabies and tuberculosis. HIV has a very high prevalence rate. Any fever during the stay or in the weeks following return calls for a prompt consultation.

Malaria prevention combines protection against mosquitoes and preventive treatment decided with a doctor; against cholera and typhoid, vaccination and food hygiene are the basic measures.

Drink only bottled water, sealed drinks or water made drinkable (filtration, boiling or, failing that, a disinfectant product). Wash your hands regularly, peel or wash fruit and vegetables well, and avoid raw or undercooked food, raw vegetables and cold buffets.

Against mosquitoes: covering clothing, repellents, treated mosquito nets, removal of stagnant water.

Other everyday risks relate to the road (do not drive at night, avoid minibuses), swimming (supervised areas only), contact with animals (do not touch or feed them, immediately wash any bite or scratch with soap and water and consult a doctor), envenomation (closed shoes) and risky behaviour, which exposes you to sexually transmitted infections in a country where HIV prevalence is very high.

Before departure, consult a family doctor or an international vaccination centre early enough, then compare the CFE or private insurance.

For pregnant women or those planning a pregnancy, France Diplomatie recommends consulting before travel because of Zika, whose neurological complications and malformations in the foetus are possible. Mpox can be serious in children, pregnant women and immunocompromised people: after a risky contact, a doctor must be consulted.

For children, the vaccination schedule and boosters are brought up to date before departure, with tuberculosis vaccination for under-15s on frequent or prolonged stays, and rabies for young children and stays in rural areas or far from towns. For a chronic illness, check with your doctor the continuity of treatments, the availability of medicines and the insurer’s coverage, taking into account the medical history to be declared; see medical questionnaire and history.

France Diplomatie describes a contract covering all medical costs, surgery, hospitalisation and medical repatriation as necessary. Three routes exist: the CFE, with membership before departure or within three months of settling in for immediate cover; international first-euro insurance, with direct payment and evacuation; the protection of a secondment.

The comparison is made on the coverage area, hospitalisation ceilings, maternity, evacuation and the medical questionnaire; see coverage area.